Can the question-behaviour effect enhance uptake of cardiovascular health checks in primary care?

Abstract

Background In England, a national programme of health checks to identify cardiovascular disease risk is being rolled out, but encountering difficulties with low uptake. This trial examined whether an enhanced invitation method, using the question-behaviour effect (QBE), with or without offering a financial incentive for returning the QBE questionnaire, increased uptake of health checks. Methods: Three-arm randomised trial (ISRCTN42856343). All individuals (n=12,459) invited for health checks from 18 general practices in London were randomised to either: (i) standard invitation only, ii) QBE questionnaire (Theory of Planned Behaviour and anticipated regret items) followed by standard invitation; iii) QBE questionnaire with financial incentive offered for questionnaire return, followed by standard invitation. The primary outcome, a completed health check, was objectively assessed from electronic health records. Outcome data was available for 12,052 participants. Findings Health check uptake was: Standard invitation, 590/4,095 (14.4%); QBE questionnaire, 630/3,988 (15.8%); QBE questionnaire and financial incentive, 629/3,969 (15.9%). The increase in uptake associated with the QBE questionnaire was 1.43% (95% confidence interval -0.12 to 2.97%, P=0.070) and for the QBE questionnaire plus offered incentive was 1.52% (-0.03 to 3.07%, P=0.054). The difference in uptake associated with incentivising QBE questionnaire return was -0.01% (-1.59 to 1.58%, P=0.995). Discussion An enhanced invitation method using the QBE does not increase health check uptake a clinically significant amount, regardless of whether QBE questionnaire return is incentivised. These findings add to growing evidence that the QBE has only a small effect on screening uptake.